Prostate Cancer Can Be Sneaky

Science & medicine

If Men Will Watch Closely For The Symptoms And Talk To Their Doctors, The Survival Rate Goes Up.

March 3, 1996|By Delthia Ricks of The Sentinel Staff

One of the most silent cancers - its early symptoms sometimes mistaken for the vagaries of aging - also is among the leading killers of men.

Prostate cancer.

The diagnosis can strike fear in patients, but doctors say there is hope for long-term survival when men recognize the symptoms early and discuss them openly with their physicians.

''This used to be a closet kind of thing . . . you just didn't talk about it,'' said Dr. Abraham Woods, a urologist, surgeon and member of the American Cancer Society's team of experts on prostate cancer in Orlando.

The society estimates that prostate cancer will strike 244,000 men this year and will kill 40,000. The disease is the second-leading cause of cancer death among men.

The take-home message: Symptoms often are so understated that many afflicted men have no idea that cancer is growing.

A change in urine flow can be a symptom of prostate cancer, Woods said, and should not be ignored. Many men, elderly ones particularly, may write off delayed or interrupted urine flow as a consequence of age.

''We're learning now that with prostate disease, men should feel free to talk about their symptoms,'' Woods said, because early cancer detection can determine whether the cancer should be treated immediately or left alone.

While some men die of prostate cancer, most who live to age 80 will have malignant cells in their prostate gland.

''More men die with prostate cancer than who die of prostate cancer,'' said Woods, emphasizing that the tumors usually are slow-growing, especially among elderly men because hormone levels decline with age.

Many men with prostate cancer have no noticeable symptoms, or they may have those (such as interrupted urine flow) that also occur in prostate enlargement. It is important for a physician to make the distinction.

Blood drops in the urine, another possible sign of prostate cancer, is the startling symptom that often spurs men to see their doctors.

Most urologists recommend an annual rectal examination and blood test for all men 50 and older. For black men, who have one of the highest prostate cancer rates in the world, screenings are recommended starting at age 40.

Dr. Judd Moul of the Walter Reed Army Medical Center in Washington has found in a controlled study that black men often develop more aggressive tumors and with greater volume. As a result, Moul said, black men often die younger of prostate cancer.

Moul's studies are the most recent to link race to differences in prostate tumor growth. No one knows why this difference occurs.

Dr. James Dugan and colleagues writing recently in the Journal of the American Medical Association, however, have developed a new prostate cancer formula. It can determine which prostate tumors require surgery, including those that are so slow-growing they can be left untreated.

The prostate gland, about the size of a walnut, surrounds the urethra at the base of the bladder. It produces an alkaline, opalescent fluid that is part of the makeup of semen.

Scientists suspect cancer occurs as a result of lifelong hormonal bombardment of the gland. Testosterone, the male sex hormone, is broken down to a second one called dihydrotestosterone, which is thought to be the cancer-causing agent.

The American Urological Association and the American Cancer Society recommend an annual blood screening known as PSA - or the prostate-specific antigen test that helps determine if a man has cancer.

With the test, more cancers have been detected at an earlier stage.

However, benefits of the screening remain unproved, and controversy taints it because of a nearly sixfold increase in prostate removals in recent years.

Prostate surgery is debilitating, causing more post-surgical problems, such as pain and incontinence, that can affect quality of life. Not all patients who have signs of cancer require prostate removal, doctors say.